Headache Differential Diagnosis

The following is a comprehensive differential diagnosis for headaches, categorized for clarity and emphasis on critical conditions.

• Single Most Likely Diagnosis

  • Tension headache: This is the most common type of headache and is often described as a band or a squeezing sensation around the forehead, usually mild to moderate in intensity. It's frequently associated with stress, poor posture, or muscle tension.

• Other Likely Diagnoses

  • Migraine: Characterized by severe, throbbing pain, usually on one side of the head, and can be accompanied by nausea, vomiting, and sensitivity to light and sound.
  • Cluster headache: Extremely painful, occurs in cycles or clusters, and is often accompanied by nasal congestion or eye watering on the same side as the headache.
  • Sinus headache: Caused by inflammation or infection of the sinuses, leading to pain and pressure in the face and head.
  • Medication overuse headache: Resulting from the frequent or excessive use of headache medications, leading to a rebound effect and worsening headache symptoms.

• Do Not Miss Diagnoses

  • Subarachnoid hemorrhage: A life-threatening condition caused by bleeding into the space surrounding the brain, often presenting with a sudden, severe headache (often described as "the worst headache of my life").
  • Meningitis: Inflammation of the protective membranes covering the brain and spinal cord, which can be caused by infection and presents with headache, fever, and stiff neck.
  • Temporal arteritis: Inflammation of the blood vessels in the head, which can lead to blindness if not treated promptly, presenting with headache, jaw claudication, and visual disturbances in older adults.
  • Brain tumor: Although rare, can cause headaches due to increased intracranial pressure, often worse in the morning and accompanied by nausea and vomiting.
  • Stroke: Can present with a sudden, severe headache, among other symptoms like weakness, numbness, or difficulty with speech and vision.

• Rare Diagnoses

  • Trigeminal neuralgia: A chronic pain condition that affects the trigeminal nerve, causing intense shock-like or stabbing pain in parts of the face.
  • Occipital neuralgia: Involves the occipital nerves and can cause severe pain in the back and side of the head.
  • Hypnic headache: A rare headache disorder that occurs only during sleep and wakes the patient up, typically in older adults.
  • New daily persistent headache: A rare type of chronic headache that starts suddenly and persists daily from the onset, often without any identifiable cause.

Each of these diagnoses has distinct characteristics and requires careful consideration based on the patient's history, symptoms, and physical examination to ensure accurate diagnosis and appropriate treatment.